We lost 2 patients in one day, 15 minutes one from the other.

Then the next day, another one

and we have one more, invasive fungal sinusitis ... no white count whatsoever... 2nd failed BMT ... its like dead man walking ... he is doomed. No mater how much antifungal we tank him up with, he still needs his whites to fight the damn fungi out of his system.

I have been here for 4 weeks and already 6 patients have died in the unit.

Onc is tough, and frustrating. Its making me feel like the damn Angel of Death.

Stethoscope

I don´t know if Ive talked about this before or not, but I never carry my stethoscope around my neck. There are 2 main reasons for that.
One of the is that I actually find it heavy and the Littmann website suggest you NOT to carry it around the neck since the contact of the tubing with the lipids in the skin may cause stiffening of the former.
The second reason is that I associate the stethoscope with internists. No other doctors really carry around their stethoscope the whole day. They use it, they just don't go through life with it around their neck.

Since last year I have refused to be associated with Internal Medicine in any way possible. So one of my subtle ways of setting myself apart is by carrying my stethoscope in my pocket. I know it sounds pretty idiotic, but to me is like a secret way of showing my disagreement for them.

No one really gets it ... or so I though.

Yesterday my fellow classmate and I had a meeting with one of the ENT attendings with whom we are working on a proyect. We had to sneak out of our Onc activities in order to attend.
When we got there:

ENT ATTENDING
Hey guys! How have they been treating you in Onc?
(Shakes hand, and notices the stethoscope on my classmate's neck)
Ohhh, nooo!
A Stethoscope!
You have passed to the dark side now! haha
(turns to look at me)

ME
No, no Doctor.
Mine is safely kept inside my pocket.
(point to my stethoscope shoved inside my coat's pocket)
I am NO internist.

ENT ATTENDING
A true surgeon.
Keeping faithful to ENT
:D

HOLLY FUCKIN SHIT

I JUST REALIZED


four more weeks ... FOUR ... F-O-U-R W-E-E-K-S

and i will have officially finished my training as a physician

SHIT

when the fuck did his happen?!

looking for empathy in the wrong places

I have 3 siblings. Of the four of us, all but one have eye refractive errors. The rest have required glasses since maybe 4th grade to correct them. My little sister and myself are particularly screwed because not only do we have an obvious dependency on glasses, but also our retinas are starting to get messed up too.
You see, I have what is called high degree axial myopia, meaning my eyes are too big for my corneas and lenses to focus appropriately on far objects and thus I am legally blind without my contacts or glasses. Pero bueno todo sea por mis ojotes tapatios!
These type of eyes have a greater susceptibility to degenerative retinal changes, including retinal detachment. If we were fatalist people, which I clearly am, we could interpret this to mean that I could go blind all of a sudden. Anytime. Permanently. If only I was ignorant about this tiny tiny fact, it would all be easier.
I am not a candidate for refractive surgery, since I have a borderline thin cornea and my degree of myopia would require shaving off most of it, leaving me with a keratoconus. Which is clearly not desirable.
I usually always wear contact lenses, actually most people have never seen me with my glasses. I do this not only because I hate how I look with glasses, but also because when people see my thick glasses they always go: "No manches que gruesos! Estas super ciega, porque no te operas?" And everytime I have to take a deep breath, and hold myself from bursting: "A ver ignorante, si tus dos malditas neuronas hicieran sinapsis y te dieras cuenta que la respuesta a tu pregunta esta implicita en tu comentario, nos ahorrariamos este momento embarazoso para ambos. Lets break it down for you, shall we? Que gruesos! = my refractory error must be quite considerable. Estas super ciega = further states the latter. Porque no te operas? = Exactly because of what you've just said, ass! Estoy super ciega! Claramente no tienes ni el mas remoto entendimiento sobre las bases de la cirugia que estas proponiendo. SO, SHHHTT IT!" You can understand why I rather just stick to the contacts. I do not posses all that self control or patience.

So anyways, yesterday my middle sister, the formerly 20/20 vision sister, was diagnosed with a MILD refractive error. Let me say that again, M-I-L-D. It would be barely noticeable except for the fact that she is a designer and has to be in front of a computer for the better part of the day messing around with lines and graphs and whatever it is that she does. She was prescribed glasses, more specifically -0.50D glasses. I tried to be supportive. You know, being the big sister and a doctor and shit I was all like: "its great, you are going to see so much better, your eyes won't get as tired, bla bla".

But when she told me how "depressed" she was and how "sad" this whole thing made her I was like, Honey, you won't get no empathy from me! Go tell your shitty-ass whining to someone with a perfect vision, not to a legally blind person!! Not to the person who has cried on her last four Ophtha checkups! Come on! You surely don't expect ME to comfort YOU! Just appreciate I'm not laughing at your damn -0.50D prescription.

So whats with this tangent?

I have an aphthous ulcer.

I have an aphthous ulcer on my lower lip frenulum. It hurts like FUCKING HELL. I tried eating my lunch today and literally a tear came down my cheek. For the whole day I couldn't get over my ulcer. It is such a pain. God! But I haven't told anyone.
Wanna guess what my patients diagnosis is?
MUCOSITIS.

She is on PCA morphine for pain control and on TPN because she can't take PO. Because of the PAIN.

Fuck.

Buh Bye Surgery, Hello Medicine

I know how to excell in surgical rotations. I know my way around the OR. I know how to be helpful, not just with the residents and doctors, but the nurses and anesthesia too. Im pretty sure mom and dad had a lot to do with it, all that "ACOMIDANSE! No nomas esten ahi parados" and "gusto les deberia dar sentirse utiles" really sunk in.

I like surgeons, and I think most of them they like me. It just fits my personality. I'm a hard-worker tough girl. I really am. I can take a lot of shit, both phisical and verbal. Emotional, not so much. But I can just suck it, and keep working under rough circumstances.

I think here in the States this has been much more noticeable. Back in Mexico you had to be hardcore sometimes, just to get through. There is no way the surgeon would give you a "bathroom break" or a "lunch break" during a case. It was either all in or just stay out of it. People here get post-call days off, on Q4! haha residents in Mexico dont get hours restrictions. You could be at the hospital for days at a time. And dont even think about opening your mouth about it, because you could land an extra day for complaining. I know it sucks, I don't support this system. Yet, it has helped me be tougher than most medstudents (and even residents) here. People are surprised that I sometimes dont go home on postcall days, or that I come round on weekends, and I'm all "thats how we roll in Mexico, man!"

Ok, enough tangent. What I want to say is, it takes me just a couple of days to figure out surgical rotations. I know how to excell in surgical rotations. But I have absolutely no idea about Medicine rotations.

Starting this Monday I'm on Hemato/Oncology.

Its a strange world to me, internal medicine. I feel akward around internists, like they are judging me and thinking how stupid I am. Which being honest, is probably what they are doing indeed. They look at people with resent. I think its because they know so much yet their lifes usually suck so bad, they blame happy people for it. These damn boring geeky people. I know I sometimes say I'm a geek, but I'm sooo not this type of geek, Im a cool, easy-going geek.

So anyways, we'll see how it all goes on Monday. Any suggestions on how to get internists to not hate me will be appreciated. I will definitely not go so far as to try and get this people to like me, cause you know, it would be easier to get a monkey to learn to stepdance and get him into Riverdance.

Last day

So, my ENT rotation is over. Friday November 6 was my last day, and it couldn't have been more perfect. My very last case was a partial mandibulectomy, modified radical left neck dissection with preservation of SCM and spinal nerve, reconstruction with a vascularized bone-containing free flap from the fibula, and skin graft to cover the donor site. All this for a highly differenciated invasive Squamous cell carcinoma. DUDE! Even writing this gives me the chills!It was a mother-fucking monster case that lasted since 8am to about 9:30 pm.

Did I care I was standing up for 12 hours straight? No! I was on such an adrenaline high during the whole case, I barely cared about my swollen feet. Did I care that my only meal that day was half a glass of orange juice and a muffin I had at 7am? Hell no! Eating is for pansies. I got to close the donor site defect, and I fucking took the skin graft. ME! I slided the dermatome and TOOK the graft. Internet, I was soo awsome.

I love it that ENTs here can be hardcore surgeons. With the drill, and the hammer, and all the blood and bone splashing all over our goggles and gowns. This is what I want to do. This is exactly what I want to become. Internet, I know I sound like a freaky blood thirsty person, and I probably am to some extent. But you just had to be there. You had to be there to appreciate the talent a surgeons need to not panic when the frikin i yugular perfs and streams of blood that soak your shoes start coming out someone's neck. The skill it takes to keep you mind cool, detect the bleeding source, clamp it, suction, tie, and move forward. These are real people we are dealing with, and decisions taken within seconds can drastically change an outcome. Lifes are on the line. I don't just like bloody surgeries. I like surgeries that succed, that help improve a patient's life, that save lifes. The blood is just an extra.

Even though I'm sad it is all over now, I can't help but look back and smile. I loved every moment of this past 6 weeks. I learned a lot, not just ENT stuff, I learned a lot about myself. I had a great time. I realized I can wake up by myself everyday at 5am, which I'm sure no one ever though possible. Me included. Its just, I finally found something that is worth it.

So internet, I was definitely out with a bang!

ENT Vs. Penis Doctors

ENT RESIDENT
Hey man! How are you doing?
(turns to me)
This is XXX, we did our intern year together. He is a PENIS doctor now.

UROLOGY RESIDENT
Dude! Why do you have to say PENIS doctor?! Just say Urologist.

ENT RESIDENT
Don't be ashamed, man. Be straigh forward about your deal. We are ENTs, Ear Nose and Throat. We don't hide behind Otolaryngology.